Optimizing Metabolism

by Ingrid Kohlstadt MD, MPH

2015 Healthy Aging Summit: What’s Coming and What’s Not

The 2015 Healthy Aging Summit was held July 27–28 in Washington, DC. Congress was in recess, street parking was ample, and the Potomac River was shrouded in mist until late morning. But inside the conference halls there was a strong sense of mission. Attendees were passionate about health and vitality in older age and had diverse profession vantage points. This conference would herald the next wave of health-care resources and how to tap into them. In this column, I elaborate on how practitioners of integrative medicine might be able to catch the wave.

Erase That from the Smart Board

Many of the ills people chalk up to old age don’t belong there. They are diseases rather than a natural part of healthful aging. Most of the diseases either have treatments or they clue us in to other important ways to help our patients. In fact, fatigue, pain, fibromyalgia and the other aches addresses in this month’s issue of Townsend Letter are among the conditions getting a careful look-over at the National Institutes of Health.

Research scientists at NIH who are studying the biology of aging are a small group compared with their colleagues studying the biology of diseases. But they turned this seeming disadvantage into an opportunity to collaborate and name their new field of study geroscience. Geroscientists separate aging from disease. As the diseases posing as natural aging are erased from the healthful aging smart board one by one, we can make diagnoses earlier, when existing therapies are most effective.

Scientists are also hot on the trail for demonstrating age-reducing activity in small molecules and new drugs, creating an entirely new therapeutic class of drugs called senolytics. The current list includes aspirin and metformin and may soon expand to 20 more molecules. These molecules do more than treat the diseases; they seem to interrupt some other aspect of the normal aging process. The current list includes aspirin, metformin, and rapamycin. Metformin is given with diabetes as an indication, the time until onset of a comorbidity was less than the healthful aging group in one study. Rapamycin has a fascinating history. It was identified from bacteria found on Easter Island, where its antifungal properties were noted. Causing too many immune-system side effects, it was seldom used as an antifungal when it was discovered to have a chemotherapeutic action against cancer. As it turns out, the drug has now been shown to extend the life of mice, raising great interest as a promoter of longevity. It remains in the research phase.

Aging Mice and Why It Matters

While the research in senolytics holds great promise for extending longevity, it’s also shedding new and inconvenient light on some recesses of pharmaceutical research. Mice and people respond similarly – as we age we are less able to manage toxins, be they stress, junk food, or medications. Pharmaceutical animal research is usually conducted in young mice regardless of the likely age of the intended patient recipients. Now that geroscientists are studying old mice, they are finding more side effects to medications.

Fall Prevention

It currently takes 17 years for research findings to reach patients, according to David Reuben, MD, of the University of California, who is a geriatrician and member of the Institute of Medicine. Everyone agrees that this is much too long. The federal government has put $30 million toward shortening this time frame for fall prevention. Since falls are a leading cause of disability, the investment should pay off. But the voices on what to prioritize around fall prevention were reflected in the diversity of the conference.

Johanna Dwyer, DSc, RD, has long advocated for making nutrition a vital sign. She emphasizes that sarcopenia, which puts patients at risk for falls, should be recorded routinely in nurses’ notes. But little progress has been made in communicating the importance of this physical exam finding, let alone nutrient deficiencies such as vitamin D and vitamin B12, which tend to manifest with more subtle physical exam findings.

Interagency communication remains a challenge. For example, HUD has prepared a simple and thorough checklist for how to reduce the risk of falls in the home. Attention to lighting, handrails, and carpets can be lifesaving, but presumably since the checklist was developed outside usual health channels, it is not on the NLM’s resource list for care providers.

The Riptide of Aging and Disability

The number of older people with disabilities is greatly increasing. What’s less understood is that it’s increasing in two ways: (1) people who age into disabilities and (2) people who age withdisabilities.

Here’s why health professionals will want to distinguish between these two groups even though they receive similar health-care services. Aging into disabilities is viewed as a failure of the health-care system. Disabilities in this group tend to be from preventable falls or blindness. Health professionals will want to emphasize all preventive services in this group.

In contrast, those who are aging into disabilities such as cerebral palsy, multiple sclerosis, and spinal cord injuries are a success of the health-care system, since these conditions used to preclude longevity. Unfortunately, most of the research on disabilities and aging has been conducted without this group, largely because they didn’t meet the inclusion criteria. So access to services for those aging with disabilities may require some advocacy and clear communication of the preexisting disability in the patient’s chart.

Innovations That Improve Quality of Life Around Dementia

At the summit, I was heartened by the innovations to improve the quality of life for older people with cognitive decline. For example, the Netherlands has assisted-living facilities that look like farms and villages where patients can feed the animals, tend the garden, take a walk, and sip coffee at an outdoor café. It all leads to keeping people active. Another example is an interactive robot made to look like a harp seal pup and to provide the physiologic and social components of animal therapy. Approved as a therapeutic device by the FDA in 2009, this item continues to demonstrate how fewer medications are needed and that Alzheimer’s disease doesn’t have to stop a smile.

No Ahh-Perations, a Missed Ahh-Portunity

A look inside the mouth can reveal a lot about a patient’s aging process. Simply asking the person to say “ahh” can guide the workup. Yet the summit contained no mention of dental health, and I saw no dentist on the speakers list. The closing plenary by WHO aging expert Dr. Somnath Chatterji presented a telling slide. In 1990, edentulism (toothlessness) was the 12th leading condition among the elderly worldwide. Twenty years later, it was no longer on the charts. Hopefully, the leaders in aging will have an “aha moment” that dental health is more than missing teeth.

Summary

Clinicians have important roles in the healthful aging of their patients. Integrative medicine practitioners are already diagnosing and treating diseases that have up to this point masqueraded as “normal” aging. Medications offer both benefits and downsides which become more pronounced in older age. The need for prevention is also more apparent with new resources, but advocating for those resources is still essential for now.

Ingrid Kohlstadt, MD, MPH, FACPM, FACN

Faculty Associate, Johns Hopkins Bloomberg School of Public Health

Executive Director, NutriBee National Nutrition Competition Inc.

Editor, Advancing Medicine with Food and Nutrients (CRC Press; 2013)